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Home My WebLink AboutEHPR-11-09-2520 (2).TIF THIS IS NOT A PERMIT WLS# CATAWBA COUNTY HEALTH DEPARTMENT Application for Environmental Services r- IP AC S.T. Rpr, r- S.T. Exp. r Exist. S. T. r Well Permit r Replacement Well 1. Name to Appear on Permit: p„~ e,~-`t o~. ,M ar 2. Permit Requested By: 4- S 3 0- JeX'. , ax- rf\c~. r-\ Business Phone: 76 4• o.. S e, .4 L~ 6 Address: -1U 4 mo,; d,,, (f;~ t`~Q ► ck t'-, Z~45a Home Phone: l (6q- 530-~ 26~ 3. Property Owner: FK711-1%R L4-o n VCLJ ~J . o„ e 0y- Mo_h Business Phone: ZL}b4 E i`ila_~ q,~ ~~n Z ~~Sb ~Z~ 42g 3330 Address: - - - Home Phone: 4. Name of Subdivision: Lot I Section/Block/Phase: Property Address: Zy S L~0.S-~' 0. • 'c~ I 1 ~R ~~n. ,\C. Z.-~ S _ Cfl- b Directions to Property: / - r o 1t 3 I 5 0 L. '4 c 1'1 15 0.,5`x' F e-, -'~A , aauSe, r on e,-~~` S. Property Size: Square Feet ~cres C, 4 Date Platted/Recorded 6. TYPE OF FACILITY: House C' Mobile Home Dimension of Structure12- ~-10s Bedrooms*F *Any room that will be intended for sleeping at the time of construction or. for future consideration should be noted as a bedroom and counted on all pplitons. The number of e bed for sd swill confiin he`fut rooms identified on the house plans as a'bedroom at`the'time of.building permit issuance This may pent th Ystem - s, Basement: C, Yes 1 No Water Using Fixtures in Basement: C Yes (X No No. in Family: Whirlpool Tub: C Yes A No Gallon Capacity: MULTIPLE FAMILY RESIDENCES: Units I Total Number of Bedrooms DAY CARE: Number of Children I RESTAURANT: Seats Square Feet Dining Area r Square Feet Food Stand/Meat Market Floor Space TYPE OF BUSINESS: No. of Employees 1st F- 2nd F-3rd F OTHER: (Specify) 7. Do you anticipate any additions to Facility? C Yes o If so describe _ i 8. Has any grading, removal, or addition of soil been done to this property? Yes KNo If so describe 9. Are there easements/right-of-ways recorded on this property? Yes ~No 10. Is a public water supply available on or adjacent to the above property? IIK Yes t' No Check type that is available: r Community Well Semi-public Well X County/City/Township water line 11. Well Type Applying For: r- individual Well r Community Well Semi--public Well r Irrigation Well Geothermal Well 12. Monitoring Well Request: (7 Yes (-No # of Wells: r of Site: I understand that this a formal application for a well permit, improvement Permit or Authorization to Construct a ground absorption sewage disposal system to serve the above described facility on this property and authorize Catawba County Health Department employees to go on this property for evaluation purposes. I certify the above information to be correct and understand that an Improvement Permit issued as a result of this information is transferable and may be eligible for non-expiring date, but may be revoked if this information, site plans or intended use changes for the proposed facility. A Well permit and Authorization to Construct issued by this department is valid for (5) five years from the date issued and is not transferable. Note: You must obtain Zoning Approval prior to locating a home or structure on this property. Any representation by you of house or structure location should conform to applicable set backs. **IF A PERMIT HAS TO BE REDESIGNED AND/OR RETRIPS MADE TO THE PROPERTY, THERE IS AN ADDITIONAL CHARGE.- Date: 1 _ 14 Signature of Owner or Agent: Print Form 121 ; Jill ~1 ~g- ~ I NN , Nz , NUl f~ $ W ems'. I Wm I ~F, I VZ cb LA T pp ima•~" ~-1 JJtt , b f=.1 I 'f7 I a Q 0, z tq g I sj { 00 I wx g a$ - ~rr - r- t- 6a. { EAST MAIDEN ROAD - 60'R\W i sg 8t s { N I fe A -------wnone~ ~ THi .B4Y8L~ N Yew 11A ` € o 69 MR4 J~7~ g U,4". 00 I m ~ gy .o,~, ,-.o x a Y Pmj e ~ N ~ T a § _ s x ~m I a IN IRS a p~s Jill o xNitloil' r Print Parcel Map and Report Page 2 of 2 Parcel Report - Catawba County, NC Parcel Information: Owner Information: Parcel ID: 365606478608 Name: AUTON ANN S Parcel Address: E MAIDEN RD Name2: SPEARMAN VALERIE City: MAIDEN 28650 Address: 2404 EAST MAIDEN RD LRK(REID): 201313 Address2: Deed Book/Page: 2815/1870 Deed Image City: MAIDEN Subdivision: State/Zip: NC 28650-8528 Lots: 1 Block: Last Sale: School Information: Plat Book/Pa e: 65/79 Pla Ima School District: COUNTY Calculated Acreage: 0.94 Elementary School: MAIDEN Tax Map: Middle School: MAID N State Road: 1855 Hi h School: AM IDEN Township: CALDWELL Tax/Value Information: Tax Rates(pffi Zoning Information: Municipal Tax District: COUNTY Zoning District: COUNTY Fire District: MAIDEN RURAL Zoningl: R-2 Tax Account Number: 209494 Zoningl: Market Building(s) Value: $26,800 Zoning3: Market Land value: $11,800 Zoning Overlay: Market Total Value: $38,600 Small Area: BALLS CREEK Year Built/Remodeled: 1952 SPlit Zoning District 1/2: 0/0 Current Tax Bill Zoning Agency Phone Numbers Miscellaneous: Voter Precinct: P9 Firm Panel Date: 9/5/2007 Building Code: HOUSE & LOT Firm Panel 37103656003 Building Permits for this parcel 2010 Census Tract: 011600 WaterShed: WS-II Protected Area 2010 Census Block: 5005 WaterShed Split: NO Agricultural District: Parcel Report Data Descriptions DISCLAIMER: This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user. The County of Catawba, its employees, agents, and personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. http://www.gis. catawba.nc.us/website/Parcel/pnntN4apandReport.asp?pinc=365606478608... 11/3/2009 Print Parcel Map and Report Page 1 of 2 [Estate Search leg 61 8801 L 8608 0627 ~r r1o J1p~ ~~O 9 1409 Parcel Summary Printed Map Scale 1 inch = 119ft Parcel ID: 365606478608 Parcel Address: , MAIDEN ARdddress: 2404 EAST MAIDEN City: MAIDEN Owner: AUTON ANN S I 11 Owner2: SPEARMAN VALERIE Address2: State/Zip: NC, 28650-8528 Building(s) Value: $26,800 Land Value: $11,800 Total Value: $38,600 DISCLAIMER: This map/report product was prepared from the Catawba County, NC Geospatial Information Services. Catawba County has made substantial efforts to ensure the accuracy of location and labeling information contained on this map or data on this report. Catawba County promotes and recommends the independent verification of any data contained on this map/report product by the user. The County of Catawba, its employees, agents, and personnel, disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential which arises or may arise from this map/report product or the use thereof by any person or entity. http://www. gis. catawba. nc. us/website/Parcel/printMapandReport. asp?pinc=365606478608... 11/3/2009 Catawba County, North Carolina This map product was prepared from the Catawba Courtly, NC, Geographic Information System. N Cotcmba Connty has made substantial efforts to ensure the accuracy of location and labeling information A contained on this map. Catawba County promotes and reconnnends the independent verification of any data contained on this map product by the user. The County of Catawba, its employees, agents and personnel disclaim, and shall not be held liable for any and all damages, loss or liability, whether direct, indirect or consequential tiu hich arises or may arise from this map product or the use thereof by any person or entity. Legend Selected Parcel Number: 3656-06-47-8608 1 inch = 60 feet Prepared for: \ ~O ti \ 15a 6? 2.64A 8801 Plat 65-79 3.6 8608 06 ~o 77n THIS IS NOT A LEGAL DOCUMENT Wed, November 04, 2009 01:38 PM \ \ / CATAWBA COUNTY, NC F ECEIPT 100-A South West Blvd P,H /~/I ` I Newton, NC 28658- L~/`"41 tl U as (828)465-8399 Wednesday, November 4, 2009 188 4 sM www.catawbacountync.gov Plan Case: EHPR-11-09-2520 Invoice Number: I NV-1 1-09-256973 Environmental Health Plan Review Invoice Date: 11/04/2009 Fee Name Fee Amount Authorizaticn.to Construct tRepair) Fee ~;d}ustabie. $300.00 Total Fees Due: $300.00 PAYMENTS Date Pay Type Check Number Amount Paid Change 11/04/2009. Check 2054 $::60.00 % $0.00 Total Paid: $300.00 Total Due: $0.00 plan receipt?bb6c1 4-21cf-=14?c-bldi-ci~?9~Oila6 `~!';.rpt 11/04/2009 13:33